Hospitals Feeling Strain From Illegal Immigrants

By DANA CANEDY

Published: August 25, 2002

STUART, Fla.—
In the two and a half years since Luis Jiménez arrived at the Martin Memorial Medical Center emergency room with severe brain damage from a head-on car collision, the hospital here has become his home.

In that time, Mr. Jiménez, 30, a former gardener, has emerged from a coma, had two birthdays and accumulated medical bills of almost $1 million. By all accounts, he is well enough to be discharged, but the hospital and advocates for the patient are in a conflict over his mounting medical bills and future care that makes his release unlikely without a court order.

A penniless illegal immigrant from Guatemala, Mr. Jiménez has no health insurance, and his injuries have left him with limited mobility and the mental capacity of a 3-year-old. Martin Memorial wants to send him back to his homeland for any remaining medical care. But Mr. Jiménez's advocates insist that he must remain at the hospital until it can find a suitable place in the United States or Guatemala that is willing to care for him.

The impasse is at the center of a national debate over who is ultimately responsible for illegal immigrants who require extensive medical care but have no means to pay for it. The issue has become an increasing concern for health care providers, particularly in Florida and border states with growing numbers of illegal immigrants.

Federal law requires hospitals to provide emergency care to critically ill or injured patients regardless of their immigration status. But because many illegal immigrants work in low-wage jobs that offer no benefits, and cannot qualify for Medicaid, they use emergency rooms as their primary source of routine and critical health care. As the number of such patients increases sharply in states like Florida, California, Texas and Arizona, so too does the financial burden on health care centers that treat them, hospital administrators say.

''We have people coming to our country in good faith to work, but we have no system in place as a nation as to what to do when these people get sick,'' said Pat Austin, a spokeswoman for Martin Memorial. ''Each hospital is left to kind of figure out what to do for itself.''

The hospitals insist that they are not turning away critically ill or injured people, but they are becoming more aggressive in seeking ways to release them. Some hospitals are going to court seeking permission to discharge patients like Mr. Jiménez. Federal lawmakers are seeking financial aid to reimburse hospitals for treating indigent illegal immigrants, and some hospitals have taken unusual steps, including putting nurses on planes to fly the patients back to their own countries.

Such measures, though, have done little to stem the rising costs, the health care providers say.

''We have tried to work on this for years, but the problem has gotten more acute,'' said Sheri Jorden, senior policy director for the Arizona Hospital and Healthcare Association. ''Hospitals have been writing these bills off with great difficulty.''

According to a study released last month by the National Association of Counties, 86 percent of 150 counties nationwide reported an increase in uncompensated health care expenses in the last five years. Of those reporting an increase, 67 percent cited a growing number of immigrants as a factor in the rising costs for county hospitals and rescue services.

''Most of the counties receive money from the state and federal government,'' said Jacqueline Byers, director of research for the association, ''but it is not nearly enough to meet the growing need.''

According to the Immigration and Naturalization Service, the number of illegal immigrants in the United States increased to as many as eight million in 2000, the last year for which figures are available, from five million in 1996. By some estimates, hospitals are collectively writing off as much as $2 billion a year in unpaid medical bills to treat the illegal immigrants, who, unlike American citizens and permanent residents, are ineligible for Medicaid.

In one case at Martin Memorial that was resolved in February, an illegal immigrant from Jamaica arrived at the emergency room with a sore on his leg and stayed in the hospital for 17 months.

''He said he had a green card but couldn't find it,'' Ms. Austin said. ''The doctors found a serious vascular disease and he had to have both legs amputated.''

''After his surgeries, when he was well enough, we had a great deal of difficulty figuring out what to do next,'' Ms. Austin added. ''We eventually found some relatives and a physician in Jamaica who was willing to accept him, and one of our nurses flew with him to Jamaica. By the time all that happened, it had cost us probably over half a million dollars.''

In the case of Mr. Jiménez, Martin Memorial says it has already incurred nearly $900,000 in expenses for which it has no hope of being paid.

''We feel there needs to be a national program of some sort that would cover these individuals with insurance,'' Ms. Austin said, ''or in the case of catastrophic events, allow the hospital a chance of repayment.''

Martin Memorial has been unable to release Mr. Jiménez because the patient's guardian and the hospital cannot agree on a discharge plan. The hospital has petitioned a judge for permission to send Mr. Jiménez back to Guatemala. No state medical center will accept him, since his immigration status makes him ineligible for Medicaid.

Mr. Jiménez's lawyer contends that the hospital has not provided enough information about where the man will be placed and who will treat him. Mr. Jiménez's family in Guatemala does not have the money to pay for his care.

''The hospital is saying he's occupying a bed and we need to get him out,'' said Michael Banks, a lawyer who has donated his services to Montejo Gaspar, Mr. Jiménez's cousin by marriage and his court-appointed guardian. ''We have made it unequivocally clear that we have no problems sending Mr. Jiménez to Guatemala, but we feel a plan is not in place.''

In Arizona, where hospitals have grappled with similar problems, the University Medical Center in Tucson wrote off more than $3 million in costs between July 2000 and June 2001 that it incurred from treating uninsured immigrants, said John Duval, chief operating officer for the center. ''I don't know that there's a societal solution to the problem,'' Mr. Duval said, ''but we are doing an enormous amount of heavy lifting with no compensation.''

Another Arizona hospital, Southeast Arizona Medical Center in Douglas, filed for bankruptcy and nearly closed in 1998 because of the rising costs of treating illegal immigrants. The problem has become so bad in Arizona that a state program that provided free dialysis and chemotherapy for legal and illegal immigrants will run out of money in a couple of months.

The issue has prompted hospitals in several states to seek assistance from sympathetic lawmakers. Senator Jon Kyl, Republican of Arizona, introduced a bill in January 2001, co-sponsored with Senator John McCain, Republican of Arizona, and Senator Dianne Feinstein, Democrat of California, that would provide $200 million a year for four years to reimburse health care providers in border regions.

Representative Jim Kolbe, Republican of Arizona, introduced a similar measure in June 2001 that would establish a $50 million reimbursement program for hospitals and ambulance services in his state. The Border Hospital Survival and Illegal Immigrant Care Act would guarantee that medical providers are compensated for treating illegal immigrants. Both bills are stalled in committees.

''It is not a top priority for many,'' Mr. Kolbe said. ''It does happen everywhere, but where you see it every day is here along the border.''

Photo: Luis Jiménez in his room at Martin Memorial Medical Center in Stuart, Fla., at the end of a visit with his cousin Juana Gaspar and her son, Lucas. (David Friedman for The New York Times)